Can ICSI and IMSI Help Treat Male Factor Infertility?

Keeping track of the alphabet soup of acronyms used to describe assisted reproductive technologies (ART) can be as hard as learning a new language. Just try to write one sentence about ART without using at least one acronym! The Pulse is here to help you make sense of two technologies sometimes combined with in vitro fertilization (IVF) to help select the best sperm for fertilization before transfer. These technologies are called ICSI and IMSI. Reproductive endocrinologists and fertility centers offer these procedures to the nearly 1 out of every 6 couples who can’t conceive.

How do ICSI and IMSI help?

ICSI and IMSI can increase a couple’s chance for a successful conception with IVF, especially in cases when male infertility has been identified. At the time of IUI or IVF cycles, embryologists (the scientists trained to work in fertility labs or clinics) generally do a basic semen analysis to provide beginning feedback about the quality of the male’s sperm sample.

ICSI stands for intracytoplasmic sperm injection. In ICSI, an embryologist uses a specialized microscope to select a single normally-appearing sperm to inject directly into the egg (also called the oocyte).

IMSI uses ultra-high magnification to select the best sperm cells for ICSI. IMSI stands for intracytoplasmic morphologically selected sperm injection. The major difference between IMSI and ICSI is that the embryologist uses a higher magnification on the microscope to identify tiny defects in the sperm head that would not otherwise be visible with standard ICSI.

Male Infertility Is More of A Problem Than You May Think

In up to one-half of couples experiencing infertility, the problem is with the guy. However, we also know that sperm-related problems could cause as many as 80% of all miscarriages. The mystery of male infertility can be challenging to solve, but ICSI and IMSI offer some couples hope.

Male infertility is becoming more common – a recent study reported that male fertility has decreased by 50% since 1973. Research shows that environmental, lifestyle, and age-related factors can limit men’s sperm health over time. Sperm are at their highest quality when a man is 30-35 years old. Because more and more couples choose to become parents later in life, male infertility is more common. More male factor infertility has driven the development of newer sperm testing and treatment options for male infertility, like ICSI and IMSI.

What types of couples can ICSI and IMSI help?

ICSI can help couples experiencing infertility when:

  • There are too few sperm for IUI or IVF.
  • There is a high percentage of abnormal sperm (teratozoospermia)
  • Eggs have not been fertilized by traditional IVF, regardless of the condition of the sperm.
  • In vitro matured (previously frozen) eggs are being used.
  • You or your partner previously had a vasectomy.

IMSI is reserved for cases of severe male infertility where there are multiple problems such as abnormal appearance, impaired motility, or small numbers of sperm, such as teratozoospermia.

What Do ICSI and IMSI look for in male sperm?

Normal sperm have a tiny, round head and a long tail. Surprisingly, in a typical sperm sample, only 4 -10% of sperm look normal when viewed under a microscope. Abnormal sperm can have a malformed head, a crooked tail, or even two tails. These defects make it harder for the sperm to fertilize the egg.

Male fertility experts disagree about how much sperm’s size and shape determine the chances of successful fertilization. All they know for sure is that fertilization won’t happen if 100% of the sperm are abnormal.

Abnormal appearance can increase the risk of implantation failure and miscarriage. Abnormal and normal-appearing sperm can also show changes in their genetic material, called DNA. It is this DNA that sperm contribute to the egg when they fertilize it. So if the DNA they donate is damaged or fragmented, implantation is less likely, as is a live birth. Other tests, different from ICSI and IMSI, are now available to test for sperm DNA fragmentation rate.

How much do ICSI and IMSI improve the chances of successful conception?

ICSI fertilizes 50% to 80% of eggs. ICSI seems to have better success rates in men with abnormal DNA in their sperm. Given its proven track record, two out of every three IVF cycles completed in the US now use ICSI. However, live birth rates of IVF with ICSI are similar to traditional IVF without ICSI, so it is unfortunately not guaranteed that if you have ICSI, you will be able to have the baby you so desperately want.

The data on IMSI are conflicting, and for this reason, it is not as routine a part of IVF cycles as ICSI. In addition, the data supporting whether IMSI is worth the extra price tag is conflicting, according to the Human Fertilization and Embryology Authority in the UK.

How much do ICSI and IMSI cost?

As you prepare for your first or next IVF cycle, you may want to consider talking with your fertility doctors about whether or not they recommend using ICSI or IMSI. ICSI adds anywhere from $800-$2,500 to the cost of IVF, depending on where you have it performed. If your insurance policy doesn’t cover IVF with ICSI, you’ll probably have to pay the entire cost upfront.

IMSI costs approximately double the cost of ICSI. The reality today is that IVF labs do not use IMSI on a regular basis. IMSI is typically reserved for cases of severe male infertility because the cost is so high.

Making the call on ICSI and IMSI

The true value of ICSI and IMSI lies in the differences among individual patients. That is why it is important that you talk with your fertility specialists about whether they think it makes sense for you to add on ICSI or pursue IMSI.

The reality is that these expensive technologies help some IVF patients more than others. For example, ICSI has not yet been shown to be more effective than IVF without ICSI in patients without male factor infertility.

You may want to consider investing in the extra cost of ICSI if sperm tests have shown your partner has severe male infertility, if you have experienced multiple failed IVF cycles, or if you are using previously frozen eggs for your IVF cycle. Another critical factor when making your decision is that IMSI is more likely to result in multiples (twins or triplets) than ICSI.

Some couples find it helpful to consider how else they could spend the $800-$2500 for ICSI during their fertility journey. For example, $1,500 can likely cover the cost of your interest payments (presuming an 8% APR) for a whole year if you financed your IVF treatment. It can also pay for nearly half the cost of a frozen transfer (typically around $3,000) of additional embryos or psychological counseling during your treatment.

Ultimately you should have multiple conversations with your partner and your fertility specialist about the best option for you as you prepare for your next IVF cycle. While new technologies are exciting, do your research to better understand the best use of your fertility dollars on the expensive infertility journey.

Amy Harris
Amy Harris is a certified nurse-midwife with a Master's Degree in Maternal and Child Health from Harvard Chan School of Public Health. Her passions are health literacy and women's reproductive health. A recent two-year sabbatical with her family in Spain was the impetus for becoming a freelance women's health writer. An exercise nut, she is happiest outdoors and on adventures abroad.

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